NRT Sampling and Selection to Increase Medication Adherence

Adherence is a critical target for successful smoking cessation, with good adherence
associated with a three-fold increase in cessation rates relative to poor adherence.
Psychoeducational interventions focused on increasing adherence to NRT do not result in
behavioral change (e.g., smoking cessation). Experiential approaches, such NRT sampling with
PQAs, are based on learning theory models of behavioral change and have resulted in increased
motivation, self-efficacy, adherence, and abstinence relative to psychoeducation or
motivational interventions. However, nicotine sampling still relies of the participant using
NRT outside of session, which may not occur. Providing an experiential intervention in which
the NRT is sampled and any problems with NRT reframed during the session may provide a
powerful learning experience that can increase in home sampling with PQAs and long-term
adherence, ultimately increasing the likelihood of smoking cessation. This may be
particularly relevant for low-income smokers who hold more negative views of NRT, have lower
health literacy, and are less likely to use medication during cessation attempts.

Inclusion Criteria:

a) 18 years or older; b) qualifying as low income (as defined by making <150% above the
poverty line or <$22,260 as a single or <$45,570 for a family of four); c) Smoking at least
5 cpd for the past year and a CO>8ppm to ensure daily smoking. This relatively low cutoff
was chosen due to the expectation of enrolling a large >50% African-American who average
<10 CPD compared to Whites who average ~15 CPD.; and d) English speaking.

Exclusion Criteria:

a) Living in a restricted environment (e.g., prison or jail facility, etc.); b) Pregnant or
nursing (all women will be required to use an acceptable form of contraception); c)
Currently enrolled in a smoking cessation treatment program, using NRT products, or
prescribed bupropion or varenicline; d) Known allergy to any of the nicotine replacement
products or sensitivity to adhesive used in nicotine patches; e) Trouble breathing, a
pulmonary condition, or sinus problems; f) Within one month post-myocardial infarction or
untreated severe angina; g) poor dentation or temporomandibular joint (TMJ) problems such
as unable to use nicotine gum; h) Cognitive impairment or unstable psychiatric condition
that interferes with the informed consent process (individuals stable on psychiatric
medications will be included); or i) Daily or exclusive use of other tobacco products
(e.g., electronic cigarettes, little cigars, etc.).